The Brazilian Butt Lift – Popular, But Is It Safe?

The Brazilian Butt Lift

Increasingly in popularity.      There’s no question that the Brazilian Butt Lift (or liposuction with fat grafting to the buttocks) has become very popular.  I, like many cosmetic surgeons, am seeing more and more patients who are requesting this.  However, like any new procedure, it takes time before the safety and effectiveness is fully understood.

How safe is it?     Let me say at the outset that we have seen no problems from our own personal experience performing this procedure.  However, recently, concerns have been voiced.
I first heard about a number of unconfirmed deaths while attending a meeting in Chicago last year.  The speaker was careful to point out that these cases were not well documented and indeed, many, if not all, were probably performed by unqualified individuals.

What is the risk?      The biggest potential risk is injecting fat into veins which could allow the fat to travel to the heart or lung in the form of a fat embolus.  Certainly, there is no way to entirely eliminate risk in any surgery, but we are always trying to minimize it to the extent possible and avoid performing procedures that carry significant risk.
The Journal of Plastic & Reconstructive Surgery recently published an article written by a group of authors who surveyed the medical literature and, after reviewing about 4000 patients, ultimately found a .12% incidence of fat embolism.   This equates to about 1 in every 1000 procedures.  For a purely cosmetic procedure, that seems pretty high since fat embolism frequently results in death.

What can we do to minimize risk?      One important consideration is where the fat is injected.  Originally, it was felt more effective to inject the fat deep into the muscle, thinking that the “take” would be higher.  Since that is where the larger veins are situated, this increases the risk of embolization.  It is much safer to inject into the buttock fat, minimizing the risk of injection into the veins.  Additionally, using smaller cannulas and injecting the fat only during withdrawal of the syringe would appear to enhance safety.

How effective is it?     Unfortunately, that is quite variable.  While the initial results always look great, some of the fat is eventually absorbed and the amount of absorption varies from patient to patient.

What’s the bottom line?     We feel that, when the procedure is performed with caution, many patients will consider the risk acceptable.  After all, if we don’t re-inject the fat, it is discarded.  We carefully discuss the risks and benefits with all patients considering the procedure and have found that many wish to accept the risks and have it done.
In everything we do, the goal is to give our patients the best result but never compromise safety.  After all, the surgery that we do is elective and we owe it to our patients to educate them to the best of our ability.  I suspect that the Brazilian Butt Lift will remain popular and, with increased experience, will come increased safety.

Howard A. Tobin, M.D., F.A.C.S.